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STUDY OBJECTIVE: To describe a new technique of neovaginoplasty after a female sex reassignment surgery using a tilapia skin as a graft. DESIGN: Stepwise demonstration of a new technique with narrated video of a single case report. The patient provided oral and written informed consent. Moreover, this video report is part of a multicenter, Investigational Review Board-approved study. SETTING: Women's university hospital in Campinas, Brazil. INTERVENTIONS: Neovaginoplasty technique using tilapia skin with the following key strategies: (1) corpus cavernosum removal, (2) vagina tunnel creation, (3) mold coating with tilapia skin, (4) mold fixation, and (5) postoperative care. The patient remained with the mold coated with tilapia skin for 5 days; after this time, the mold was removed, and the tissue graft was adhered and incorporated in the new vaginal canal. After 2 months, the tissue resembled a vaginal mucosa, and the vaginal length was 8 cm. The patient has not had intercourse yet. CONCLUSION: We introduce an alternative for low-morbidity neovaginoplasty based on the experience of plastic surgery in burned grafts. The procedure described offers an alternative option to develop an anatomic neovagina with tissue similar to mucosa tissue by a simple, low-morbidity minimally invasive procedure.

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Introdução: A cirurgia de adequação genital tem se mostrado uma opção segura e confiável, com redução drástica na disforia e melhora da qualidade de vida das pessoas transgênero. A técnica mais estudada e utilizada é a inversão peniana com suas modificações, com aparência estética e funcionalidade adequadas, porém sem padronização da técnica cirúrgica. Índices de até 38% de satisfação parcial e 15% de insatisfação podem levar até 66% dos casos a realizar procedimentos adicionais. O objetivo é sugerir refinamentos estéticos na aparência da vulva e comparar com algumas das técnicas descritas, buscando aumentar a satisfação estética e funcional pós-operatória. Métodos: Estudo retrospectivo com 7 pacientes submetidas à cirurgia de readequação sexual entre agosto de 2017 e fevereiro de 2018. O clitóris é feito com a glande em formato de tridente, utilizando a coroa para construir os corpos cavernosos do clitóris e aumentar a área de sensação erógena. Faixa de prepúcio é usada para aumentar a cobertura do clitóris e cobrir a face interna dos pequenos lábios, que são definidos com o uso de suturas. Resultados: Sensibilidade adequada e satisfação com o resultado e capacidade de orgasmo em todas as pacientes observadas. Não houve estenose, fístula ou necrose do clitóris com essa técnica. Somente 1 caso precisou de procedimento adicional para melhor definição estética. Conclusão: A técnica apresentada tem alta satisfação das pacientes e sensibilidade erógena, com algumas vantagens em relação a outras técnicas. Porém, estudos prospectivos com número maior de pacientes são necessários para definir a técnica cirúrgica mais efetiva.

Introduction: Sex reassignment surgery is a reliable and safe option, which has drastically reduced dysphoria and improved the quality of life of transgender individuals. The most studied and used technique is penile inversion with modifications, which results in appropriate esthetic appearance and functionality, but the surgical technique has not been standardized. Partial satisfaction rates up to 38% and dissatisfaction rates of 15% may cause up to 66% of cases to undergo additional procedures. The objective is to suggest esthetic refinements to the appearance of the vulva and compare some of the techniques described, seeking to increase the postoperative esthetic and functional satisfaction. Methods: A retrospective study with 7 patients undergoing sex reassignment surgery between August 2017 and February 2018 was conducted. The clitoris is constructed with the glans in the form of a trident, using the corona to build the corpus cavernosa of the clitoris and increase the area of erogenous sensation. A section of the prepuce is used to increase the coverage of the clitoris and cover the inner surface of the labia minora, which are defined with the use of sutures. Results: Adequate sensitivity and satisfaction with the result and capacity of orgasm in all patients were observed. There was no stenosis, fistula, or necrosis of the clitoris with this technique. Only 1 case needed an additional procedure for better esthetic definition. Conclusion: The technique presented leads to high patient satisfaction and erogenous sensitivity, with some advantages compared to other techniques. However, prospective studies with larger numbers of patients are needed to define a more effective surgical technique.

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